Mental illness rates in the startup community are alarmingly high, yet we refuse to talk about it.

In a survey conducted at UCSF last year, 49% of the 242 entrepreneurs questioned reported a mental health condition. That’s much higher than the one in five US adults, or 20%, who experience mental illness in any given year.

Depression was the number one reported mental illness in this UCSF founders cohort, affecting a whopping 30% of the entrepreneurs surveyed. ADHD followed close behind with 29% and anxiety with 27%. These rates were elevated compared with the general US population, where 6.9% report depression and 18.1% are affected by anxiety.

If unmanaged, these mental health issues may be fatal. The startup world was shaken last year by the suicide of Cambrian Genomics founder Austen Heinz at the age of only thirty-one. Unfortunately, Heinz is not the only entrepreneur who has ended his life.

Mental illness has a stronghold on the entrepreneurial world. It’s time we started talking about it.

“Mental illness is really where some biology in the brain is not functioning right. It actually breaks down to how neurotransmitters are communicating or not communicating. There’s some really interesting brain imaging out that shows the differences between the brain of someone who lives with a mental illness versus someone who does not. You can actually see those differences and activity,” explained Courtney Lawson, Executive Director of the National Alliance on Mental Illness (NAMI) SE Minnesota.

Entrepreneurship is often glamorized by this get-rich quick, travel the world, and work for yourself idealized lifestyle. However, there is a mountain of pressure associated with running a business that can do some serious damage to the mental psyche. It’s not all unicorns and Shark Tank. It’s a meat grinder and some of us just don’t make it out.

Being an entrepreneur is akin to riding a roller coaster without a seatbelt. Often we, as founders, tie our self worth to our business. Because really, our business is our baby. We birthed it, and nurtured it, and want it to not only survive, but to thrive. Our emotions are so tightly tied to the success of the business, we just ride the ups and downs and plummet from despair to sheer ecstasy sometimes over the course of an hour.

Entrepreneurship is lonely. It’s often just you alone making your own decisions and your own mistakes. Entrepreneurs often work long hours to build and grow their businesses, and seemingly dispensable time sucks like physical activity and time with family and friends go right out the window.

Sometimes, it’s impossible to think about anything other than your business. It not only consumes all waking hours, but it creeps into your sleep. It’s easy to second guess decisions and constantly worry about time demands. There are enormous financial burdens involved in starting your own business. Some entrepreneurs borrow from family members, max out lines of credit, or cash in 401Ks to finance their dreams.

Beside these already behemoth stressors, we all are very well aware of the high rate of failure associated with startups. A research project out of Harvard Business School found that 90-95% of startups fall short of their initial projections and 30-40% are eventually forced to liquidate their assets.

We idolize unicorns, startups with valuation over $1B, and the Mark Zuckerbergs of the world. But it wasn’t all sunshine and rainbows for these companies. There were dark and desperate moments along the path to wealth and infamy. However, these points rarely get touched upon and entrepreneurs often mask when themselves or their company is faring poorly.

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Some research suggests that entrepreneurs may possess character traits that actually predispose them to experience stronger emotional states and mood swings. Entrepreneurs are often very energetic, creative, and innovative people that can easily cycle through states of depression, hopelessness, and despair, with emotions ranging as far as suicidal.

So not only are entrepreneurs burdened with a serious amount of pressure, they may already be predisposed to more severe emotions than the generation population, which may underlie the higher rates of mental illness in the founder community.

But it may not all be bad news.

In his book “A First-Rate Madness: Uncovering Links between Leadership and Mental Illness”, Nassir Ghaemi explores the relationship between extremely effective leaders in time of crisis and mental health issues. Ghaemi dove head first into the lives and medical records of powerful, effective figures like Abraham Lincoln, Martin Luther King, Mohandas Gandhi, and John F. Kennedy. He found they all had some form of mental illness, which may have made them even greater leaders in times of crises.

“It’s really interesting how leadership and mental illness seem to go hand in hand, as does higher IQ scores, with some diagnoses. Some of this research that’s happening now shows that [a mental health diagnosis] doesn’t have to be this terrible, dismal thing,” explained Courtney.

Help is available to manage mental health diagnosis. However, entrepreneurs are often hesitant or ashamed to seek professional guidance. We might try to downplay a mental illness to avoid being perceived as weak or vulnerable. We might be afraid a mental illness diagnosis would hurt an investment or diminish our level of respect with other founders or employees. We might think those affected by mental illness can’t function properly and don’t want to have that stigma attached to ourselves.

Refusal to address mental health issues in entrepreneurs does not make them go away.

We’re all familiar with the fast-paced, deadline-oriented, stress-filled lifestyle of an entrepreneur. I’m not telling you anything new here. But I challenge each of you to take some time to assess your own mental well-being.

Are we all really doing ok?

The startup community needs to step up and more openly address these issues running rampant in our founders. We need to break the stigma associated with mental illness. It’s not a weakness and it’s not your fault.

I had the opportunity to sit down with my good friend Courtney Lawson from NAMI, the nation’s largest grassroots mental health organization, to better understand mental health diagnoses, face the stigma associated with mental illness head on, and work to raise awareness of mental heath issues to build a healthier community for us all.